dsmwikiaorg-20200215-history
Psychological Factors Affecting Other Medical Conditions
DSM-II In DSM-II, this disorder is a category called Psychophysiologic disorders This group of disorders is characterized by physical symptoms that are caused by emotional factors and involve a single organ system, usually under autonomic nervous system innervation. The physiological changes involved are those that normally accompany certain emotional states, but in these disorders the changes are more intense and sustained. The individual may not be consciously aware of his emotional state. If there is a additional psychiatric disorder, it should be diagnosed separately, whether or not it is presumed to contribute to the physical disorder. The specific physical disorder should be named and classified in one of the following categories. Disorders # Psychophysiologic skin disorder # Psychophysiologic musculoskeletal disorder # Psychophysiologic respiratory disorder # Psychophysiologic cardiovascular disorder # Psychophysiologic hemic and lymphatic disorder # Psychophysiologic gastro-intestinal disorder # Psychophysiologic genito-urinary disorder # Psychophysiologic endocrine disorder # Psychophysiologic disorder of organ of special sense # Psychophysiologic disorder of other type DSM-III In DSM-III, this disorder is called Psychological Factors Affecting Physical Condition Diagnostic Criteria A'''. Psychologically meaningful environmental stimuli are temporally related to the initiation or exacerbation of a physical condition. '''B. The physical condition has either demonstrable organic pathology (e.g., rheumatoid arthritis) or a known pathophysiological process (e.g., migraine headache, vomiting). C'. The condition is not due to a Somatoform Disorder. DSM-IV In DSM-IV, this disorder is called ''Psychological Factor Affecting Medical Condition '''Diagnostic Criteria A'''. A general medical condition is present. '''B. Psychological factors adversely affect the general medical condition in one of the following ways: # the factors have influenced the course of the general medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the general medical condition # the factors interfere with the treatment of the general medical condition # the factors constitute additional health risks for the individual # stress-related physiological responses precipitate or exacerbate symptoms of the general medical condition Choose name based on the nature of the psychological factors (if more than one factor is present, indicate the most prominent): * Mental Disorder Affecting Medical Condition (e.g., a mental disorder such as Major Depressive Disorder delaying recovery from a myocardial infarction) * Psychological Symptoms Affecting Medical Condition (e.g., depressive symptoms delaying recovery from surgery; anxiety exacerbating asthma) * Personality Traits or Coping Style Affecting Medical Condition (e.g., pathological denial of the need for surgery in a patient with cancer; hostile, pressured behavior contributing to cardiovascular disease) * Maladaptive Health Behaviors Affecting Medical Condition (e.g., overeating; lack of exercise; unsafe sex) * Stress-Related Physiological Response Affecting Medical Condition (e.g., stress-related exacerbations of ulcer, hypertension, arrhythmia, or tension headache) * Other or Unspecified Psychological Factors Affecting Medical Condition (e.g., interpersonal, cultural, or religious factors) Differential Diagnosis Mental Disorder Due to a General Medical Condition A temporal association between symptoms of a mental disorder and a general medical condition is also characteristic of a Mental Disorder Due to a General Medical Condition, but the presumed causality is in the opposite direction. In a Mental Disorder Due to a General Medical Condition, the general medical condition is judged to be causing the mental disorder through a direct physiological mechanism. In Psychological Factors Affecting Medical Condition, the psychological or behavioral factors are judged to affect the course of the general medical condition. Substance Use Disorders Substance Use Disorders (e.g., Alcohol Dependence, Nicotine Dependence) adversely affect the prognosis of many general medical conditions. If an individual has a coexisting Substance Use Disorder that adversely affects or causes a general medical condition, Mental Disorder Affecting General Medical Condition can be recorded in addition to the Substance Use Disorder. For substance use patterns affecting a general medical condition that do not meet the criteria for a Substance Use Disorder, Maladaptive Health Behaviors Affecting Medical Condition can be specified. Somatoform Disorders Somatoform Disorders are characterized by the presence of both psychological factors and physical symptoms, but there is no general medical condition that can completely account for the physical symptoms. In contrast, in Psychological Factors Affecting Medical Condition, the psychological factors adversely affect a diagnosable general medical condition. Psychological factors affecting pain syndromes are not diagnosed as Psychological Factors Affecting Medical Condition but rather as Pain Disorder Associated With Psychological Factors or Pain Disorder Associated With Both Psychological Factors and a General Medical Condition. Noncompliance With Treatment When noncompliance with treatment for a general medical condition results from psychological factors but becomes the major focus of clinical attention, Noncompliance With Treatment should be recorded. DSM-5 Diagnostic Criteria A'''. A medical symptom or condition (other than a mental disorder) is present. '''B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways: # The factors have influenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition. # The factors interfere with the treatment of the medical condition (e.g., poor adherence). # The factors constitute additional well-established health risks for the individual. # The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention. C'. The psychological and behavioral factors in Criterion B are not better explained by another mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder). ''Specify current severity: * '''Mild: Increases medical risk (e.g., inconsistent adherence with antihypertension treatment). * Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating asthma). * Severe: Results in medical hospitalization or emergency room visit. * Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attack symptoms). Differential Diagnosis Mental disorder due to another medical condition A temporal association between symptoms of a mental disorder and those of a medical condition is also characteristic of a mental disorder due to another medical condition, but the presumed causality is in the opposite direction. In a mental disorder due to another medical condition, the medical condition is judged to be causing the mental disorder through a direct physiological mechanism. In psychological factors affecting other medical conditions, the psychological or behavioral factors are judged to affect the course of the medical condition. Adjustment disorders Abnormal psychological or behavioral symptoms that develop in response to a medical condition are more properly coded as an adjustment disorder (a clinically significant psychological response to an identifiable stressor). For example, and individual with angina that is precipitated whenever he becomes enraged would be diagnosed as having psychological factors affecting other medical conditions, whereas an individual with angina who developed maladaptive anticipatory anxiety would be diagnosed as having an adjustment disorder with anxiety. In clinical practice, however, psychological factors and a medical condition are often mutually exacerbating (e.g., anxiety as both a precipitant and a consequence of angina), in which case the distinction is arbitrary. Other mental disorders frequently result in medical complications, most notably substance use disorders (e.g., alcohol use disorder, tobacco use disorder). If an individual has a coexisting major mental disorder that adversely affects or causes another medical condition, diagnoses of the mental disorder and the medical condition are usually sufficient. Psychological factors affecting other medical conditions is diagnosed when the psychological traits or behaviors do not meet criteria for a mental diagnosis. Somatic symptom disorder Somatic symptom disorder is characterized by a combination of distressing somatic symptoms and excessive or maladaptive thoughts, feelings, and behavior in response to these symptoms or associated health concerns. The individual may or may not have a diagnosable medical condition. In contrast, in psychological factors affecting other medical conditions, the psychological factors adversely affect a medical condition; the individual's thoughts, feelings, and behavior are not necessarily excessive. The difference is one of emphasis, rather than a clear-cut distinction. In psychological factors affecting other medical conditions, the emphasis is on the exacerbation of the medical condition (e.g., an individual with angina that is precipitated whenever he becomes anxious). In somatic symptom disorder, the emphasis is on maladaptive thoughts, deelings, and behavior (e.g., an individual with angina who worries constantly that she will have a heart attack, takes her blood pressure multiple times per day, and restricts her activities). Illness anxiety disorder Illness anxiety disorder is characterized by high illness anxiety that is distressing and/or disruptive to daily life with minimal somatic symptoms. The focus of clinical concern is the individual's worry about having a disease; in most cases, no serious disease is present. In psychological factors affecting other medical conditions, anxiety may be a relevant psychological factor affecting a medical condition, but the clinical concern is the adverse effects on the medical condition.